DEPARTMENT OF JUSTICE

[OMB Number 1105-0080]

ACTION: The Department of Justice (DOJ), Civil Division, will be submitting the following information collection request to the Office of Management and Budget (OMB) for review and approval in accordance with the Paperwork Reduction Act of 1995. The proposed information collection is published to obtain comments from the public and affected agencies. This proposed information collection was previously published in theFederal RegisterVolume 77, Number 179, page 56860 on September 14, 2012, allowing for a 60 day comment period.

The purpose of this notice is to allow for an additional 30 days for public comment until December 20, 2012. This process is conducted in accordance with 5 CFR 1320.10.

Written comments and/or suggestions regarding the items contained in this notice, especially the estimated public burden and associated response time, should be directed to the Office of Management and Budget, Office of Information and Regulatory Affairs, Attention Department of Justice Desk Officer, Washington, DC 20503. Additionally, comments may be submitted to OMB via facsimile to (202) 395-5806. Written comments and suggestions from the public and affected agencies concerning the proposed collection of information are encouraged. Your comments should address one or more of the following four points:

--Evaluate whether the proposed collection of information is necessary for the proper performance of the functions of the agency, including whether the information will have practical utility;--Evaluate the accuracy of the agencies estimate of the burden of the proposed collection of information, including the validity of the methodology and assumptions used;--Enhance the quality, utility, and clarity of the information to be collected; and--Minimize the burden of the collection of information on those who are to respond, including through the use of appropriate automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses.Overview of This Information Collection

(1)Type of Information Collection:Revision of a currently approved collection.

(3)Agency form number, if any, and the applicable component of the Department sponsoring the collection:Civil Division, U.S. Department of Justice.

(4)Affected public who will be asked or required to respond, as well as a brief abstract:Primary: Individuals. This declaration is to be submitted annually to determine whether a broker meets the qualifications to be listed as an annuity broker pursuant to Section 11015(b) of Public Law 107-273.

(5)An estimate of the total number of respondents and the amount of time estimated for an average respondent to respond:It is estimated that 300 respondents will complete the form annually within approximately 1 hour.

(6)An estimate of the total public burden (in hours) associated with the collection:The total estimated annual burden hours to complete the certification form is 300 hours.